Prosthesis with modular extensions

ABSTRACT

A joint prosthesis system has two implant components and a bearing. One of the implant components has an articulation surface for articulation with the bearing. The other implant component has a mounting surface for supporting the bearing. At least one of the first and second components includes a recess and a stud in the recess. The joint prosthesis also includes an extension mounted on the stud and extending out from the bone-engaging surface to an end. Part of the extension is received in the recess.

CROSS-REFERENCE TO RELATED APPLICATIONS

Priority is claimed to the following application: U.S. ProvisionalPatent Application Ser. No. 61/256,527 entitled, “PROSTHESIS WITHMODULAR EXTENSIONS,” filed on Oct. 30, 2010 by Anthony D. Zannis andDaren L. Deffenbaugh. The present application is also acontinuation-in-part of the following U.S. patent applications, thedisclosures of which are incorporated by reference herein in theirentireties: U.S. Pat. No. 8,470,047 (U.S. patent application Ser. No.11/860,833) filed on Sep. 25, 2007 and entitled “Fixed-Bearing KneeProsthesis” and U.S. Pat. No. 8,128,703 (U.S. patent application Ser.No. 12/620,034) filed on Nov. 17, 2009 and entitled “Fixed-Bearing KneeProsthesis Having Interchangeable Components”.

TECHNICAL FIELD

The present disclosure relates generally to an implantable orthopaedicprosthesis, and more particularly to an implantable prosthesis having abearing component and another component supporting the bearingcomponent.

BACKGROUND

During the lifetime of a patient, it may be necessary to perform a jointreplacement procedure on the patient as a result of, for example,disease or trauma. The joint replacement procedure may involve the useof a prosthesis that is implanted into one or more of the patient'sbones. In the case of a knee replacement procedure, a tibial tray isimplanted into the patient's tibia. A bearing is then secured to thetibial tray. The condyle surfaces of a replacement femoral componentbear against the tibial bearing.

One type of knee prosthesis is a fixed-bearing knee prosthesis. As itsname suggests, the bearing of a fixed-bearing knee prosthesis does notmove relative to the tibial tray. Fixed-bearing designs are commonlyused when the condition of the patient's soft tissue (i.e., kneeligaments) does not allow for the use of a knee prosthesis having amobile bearing.

In contrast, in a mobile-bearing type of knee prosthesis, the bearingcan move relative to the tibial tray. Mobile-bearing knee prosthesesinclude so-called “rotating platform” knee prostheses, wherein thebearing can rotate about a longitudinal axis on the tibial tray.

Tibial trays are commonly made of a biocompatible metal, such as acobalt chrome alloy or a titanium alloy.

For both fixed and mobile-bearing knee prostheses, the tibial trays maybe designed to be cemented into place on the patient's tibia oralternatively may be designed for cementless fixation. Cemented fixationrelies on mechanical bonds between the tibial tray and the cement aswell as between the cement and the bone. Cementless implants generallyhave surface features that are conducive to bone ingrowth into theimplant component and rely to a substantial part on this bony ingrowthfor secondary fixation; primary fixation is achieved through themechanical fit of the implant and the prepared bone.

Tibial components of both fixed and mobile-bearing and cemented andcementless knee arthroplasty systems are commonly modular components,comprising a tibial tray and a polymeric bearing carried by the tibialtray. The tibial trays commonly include features extending distally,such as pegs or stems. These extensions penetrate below the surface ofthe tibial plateau and stabilize the tibial tray component againstmovement. In cementless tibial implants, the outer surfaces of theseextensions are typically porous to allow for bone ingrowth. For example,in the Zimmer Trabecular Metal Monoblock tibial trays, pegs with flatdistal surfaces and hexagonal axial surfaces are formed completely of aporous metal. In such trays, bone ingrowth is likely to occur along allsurfaces of the pegs, including the distal surfaces.

Femoral components of such knee prosthesis systems are also designed foreither cemented or cementless fixation. For cemented fixation, thefemoral component typically includes recesses or cement pockets. Forcementless fixation, the femoral component is designed for primaryfixation through a press-fit, and includes porous bone-engaging surfacessuitable for bone ingrowth. Both designs may include pegs designed toextend into prepared holes in the femur for stabilization of theimplant.

On occasion, the primary knee prosthesis fails. Failure can result frommany causes, including wear, aseptic loosening, osteolysis, ligamentousinstability, arthrofibrosis and patellofemoral complications. When thefailure is debilitating, revision surgery may be necessary. In arevision, the primary knee prosthesis (or parts of it) is removed andreplaced with components of a revision prosthetic system.

When the tibial or femoral implant includes extensions (such as pegs orstems) that extend into the natural bone, a revision surgery usuallyrequires a large resection of the bone in order to dislodge theextensions from the bone. This large resection not only complicates thesurgery, it also requires removal of more of the patient's natural bonethan is desirable. This removal of additional bone may furthercompromise the bone, increase the risk of onset of bone pathologies orabnormalities, or reduce the available healthy bone for fixation of therevision implant. Moreover, the large resection usually means that alarger orthopaedic implant is necessary to fill the space and restorethe joint component to its expected geometry.

This difficulty in dislodging the primary implant components from thebones is worsened by the fact that bone also grows into the extensions.Severing these connections may be problematic since not all of theseareas are easily accessible without resecting large amounts of bone.

Similar issues may be presented in other types of joint prostheses.

SUMMARY

The present invention addresses the need for a prosthesis with a modularimplant component suitable for cementless fixation that can be removedmore readily from the bone in revision surgery to conserve native bone.In addition, a method of making such a prosthesis is disclosed, as wellas a surgical method for removing such a prosthesis. While theillustrated embodiments of the invention address all of these needs, itshould be understood that the scope of the invention as defined by theclaims may include prostheses that address one or more of these needs.It should also be understood that various aspects of the presentinvention provide other additional advantages, as set forth more fullybelow. In addition, it should be understood that the principles of thepresent invention may be applied to knee prostheses as well as otherjoint prostheses, such as, for example, an ankle prosthesis.

In one aspect, the present invention provides a joint prosthesiscomprising a first component, a bearing and a second component. Thefirst component has an articulation surface and an oppositebone-engaging surface. The bearing has an articulation surface shaped tobear against the articulation surface of the first component and anopposite surface. The second component has a mounting surface and anopposite bone-engaging surface. At least one of the first and secondcomponents includes a recess and a stud in the recess. The jointprosthesis also includes an extension mounted on the stud and extendingout from the bone-engaging surface to an end. The extension has an outersurface between the end and the bone-engaging surface. A part of theextension is received in the recess.

In an exemplary embodiment, the stud is threaded and the extensionincludes a threaded bore engaging the stud.

In another exemplary embodiment, the stud defines a Morse taper post andthe extension includes a Morse taper bore engaging the stud.

In an exemplary embodiment, the first component includes a solid metalportion and the recess and stud are part of the solid metal portion. Thefirst component may further include a porous metal portion that definesthe bone-engaging surface of the first component.

In an exemplary embodiment, the porous metal portion and the extensioncomprise titanium metal foam and the solid metal portion comprises atitanium alloy.

In an exemplary embodiment, the porous metal portion, solid metalportion and extension are bonded together through sintering and theextension and the porous metal portion meet at a junction. The junctionof the extension and the porous metal portion may comprise titaniummetal foam.

In an exemplary embodiment, the joint prosthesis may include a pluralityof extensions. The first component may include a plurality of spacedrecesses and a plurality of spaced studs, each stud within one recessand each stud having an end. Each extension is mounted on a stud andbonded to the porous metal portion and solid metal portion throughsintering. Each extension meets the porous metal portion at a junction.These junctions lie in a plane. The ends of the studs do not extendbeyond the plane of the junctions.

In an exemplary embodiment, the joint prosthesis is a knee prosthesis,the first component comprises a distal femoral component and the secondcomponent comprises a proximal tibial tray.

In another exemplary embodiment, the joint prosthesis is an ankleprosthesis and the first component comprises a distal tibial component.

In another exemplary embodiment, the second component includes a solidmetal portion and the recess and stud are part of the solid metalportion.

In another exemplary embodiment, the second component includes a porousmetal portion and the bone-engaging surface is part of the porous metalportion. The porous metal portion and the extension may comprisetitanium metal foam and the solid metal portion may comprise a titaniumalloy. The porous metal portion, solid metal portion and extension maybe bonded together through sintering and wherein the extension and theporous metal portion meet at a junction. The junction of the extensionand the porous metal portion may comprise titanium metal foam.

In an exemplary embodiment, the joint prosthesis includes a plurality ofextensions and the second component includes a plurality of spacedrecesses and a plurality of spaced studs, each stud being within onerecess and having an end. Each extension is mounted on a stud and bondedto the porous metal portion and solid metal portion through sintering.Each extension meets the porous metal portion at a junction. Thejunctions lie in a plane and the ends of the studs do not extend beyondthe plane of the junctions.

In an exemplary embodiment, the joint prosthesis is a knee prosthesis,the first component comprises a distal femoral component and the secondcomponent comprises a proximal tibial tray.

In another aspect, the present invention provides a joint prosthesiscomprising a first metal component, a bearing and a second metalcomponent. The first metal component has a solid metal articulationsurface and a bone-engaging surface. The bearing has an articulationsurface shaped to bear against the articulation surface of the firstmetal component and an opposite surface. The second metal component hasa solid metal mounting surface and an opposite bone-engaging surface.The joint prosthesis also has an extension extending out from a junctionwith the bone-engaging surface of one of the metal components to anexposed end. The extension has an exposed outer surface and isconfigured for stabilizing the metal component when implanted in a boneof a patient. The solid metal portion of the metal component from whichthe extension extends comprises titanium and the exposed outer surfaceof the extension comprises a different form of titanium.

In one embodiment, the first metal component and second metal componentinclude a titanium alloy and the extension comprises commercially puretitanium. More particularly, the exposed outer surface of the extensioncomprises porous titanium.

In an exemplary embodiment, the extension comprises titanium foam. Theextension may have a thickness at the junction and the extension mayconsists of titanium foam across the entire thickness of the extensionat the junction. In an exemplary embodiment, at least part of theextension has a void space of at least 65% by volume.

In another exemplary embodiment, the exposed outer surface of theextension at the end of the extension has a different roughness than atleast a part of the exposed outer surface of the extension between theend and the junction.

In another exemplary embodiment, the extension is selected from thegroup consisting of a peg and a stem.

In another exemplary embodiment, the bone-engaging surface of at leastone of the metal components comprises porous metal. More particularly,the porous metal may comprise commercially pure titanium.

In an exemplary embodiment, the prosthesis is an ankle prosthesis. Thefirst metal component comprises a distal tibial component and theextension extends out from the bone-engaging surface of the distaltibial component.

In another exemplary embodiment, the joint prosthesis is a kneeprosthesis. The first metal component is a distal femoral componentconfigured to replace the distal end of the femur and the second metalcomponent is a tibial tray configured to replace the proximal end of thetibia. In this embodiment, the mounting surface of the tibial tray maycomprise solid titanium alloy and the extension may comprise a foam ofcommercially pure titanium; the solid titanium alloy may extending fromthe mounting surface toward the bone-engaging surface and the extensionmay be bonded to the solid titanium alloy of the tibial tray bysintering. In this embodiment, the bone-engaging surface of the tibialtray may comprise commercially pure titanium foam bonded to the solidtitanium alloy of the tibial tray by sintering. The articulating surfaceof the femoral component may also comprise solid titanium alloy and theextension may comprise of foam of commercially pure titanium bonded tothe solid titanium alloy by sintering; in this embodiment, the solidtitanium alloy extends from the articulating surface toward thebone-engaging surface and the bone-engaging surface of the femoralcomponent may comprise commercially pure titanium foam bonded to thesolid titanium alloy of the femoral component by sintering.

In another aspect, the present invention provides a joint prosthesiscomprising a first metal component, a bearing and a second metalcomponent. The first metal component has a solid metal articulationsurface and a bone-engaging surface. The bearing has an articulationsurface shaped to bear against the articulation surface of the metalcomponent and an opposite surface. The second metal component has asolid metal mounting surface and a bone-engaging surface. The jointprosthesis also has an extension extending out from the bone-engagingsurface of at least one of the metal components. The extension isconfigured for stabilizing the metal component when implanted in a boneof a patient. In addition, the extension has an exposed end spaced fromthe bone-engaging surface and joins the bone-engaging surface at ajunction. The extension has an outer surface between the junction andthe end of the extension. The texture of the outer surface of theextension at the end is different from the texture of the outer surfaceof the extension between the end and the junction.

In an exemplary embodiment, the outer surface of the extension has acoefficient of static friction at the end that is less than thecoefficient of static friction between the end and the junction.

In another aspect, the present invention provides a joint prosthesiscomprising a first metal component, a bearing and a second metalcomponent. The first metal component has a solid metal articulationsurface and a bone-engaging surface. The bearing has an articulationsurface shaped to bear against the articulation surface of the metalcomponent and an opposite surface. The second metal component has asolid metal mounting surface and an opposite bone-engaging surface. Thejoint prosthesis also includes an extension extending out from ajunction at the bone-engaging surface of one of the metal components toan exposed end. The extension is configured for stabilizing the metalcomponent when implanted in a bone of a patient. The extension has athickness at the junction and consists of porous metal across the entirethickness of the extension at the junction.

In another aspect, the present invention provides a method of making anorthopaedic implant. The method includes the steps of providing a solidmetal base and a porous metal extension to be assembled with the solidmetal base. The solid metal base has a first surface and a secondsurface opposite to the first surface. The porous metal extension andthe second surface of the solid metal base include complementarymounting structures for assembling the porous metal extension and thesolid metal base. The method includes the step of assembling the porousmetal extension and the base followed by sintering the assembly of theporous metal extension and the base to bond the porous metal extensionto the base.

The method may also include the step of providing a porous metal preformhaving a shape different than the shape of the porous metal extension.

If such a preform is provided, the method further comprises the steps ofplacing the porous metal preform against the second surface of the baseand sintering the preform to the base.

The porous metal extension and the porous metal base may comprise anintegral component and the steps of assembling the porous metalextension and the base and placing the porous metal preform against thesecond surface of the base are performed simultaneously.

Alternatively, the porous metal extension and the porous metal base maycomprise discrete components and the steps of assembling the porousmetal extension and the base and placing the porous metal preformagainst the second surface of the base are performed separately.

In one embodiment of the method of the present invention, the porousmetal extension has two ends. The mounting structure of the porous metalextension is at one end and is surrounded by porous metal. The oppositeend of the porous metal extension has different surface characteristicscompared to the porous metal surrounding the mounting structure.

The different surface characteristics of the opposite end of theextension may be achieved by treating the opposite end of the porousmetal extension to adjust its surface characteristics.

Treatment of the opposite end of the porous metal extension may comprisemachining, milling or polishing.

Alternatively, treatment of the opposite end of the porous metalextension may comprise bonding the porous metal to another material. Theother material may comprise solid metal or, in the alternative,polyetheretherketone (PEEK).

In another aspect, the present invention provides a method of removingan orthopaedic implant from a bone. The orthopaedic implant comprises abody having a bone-engaging surface engaging the bone at an interfaceand an extension extending deeper into the bone. The method comprisesthe step of introducing a saw blade between the bone-engaging surface ofthe body and the bone at the interface to separate the bone-engagingsurface from the bone and sawing through the extension to separate theextension from the body. The method may further comprise the step ofsawing around the extension.

BRIEF DESCRIPTION OF THE DRAWINGS

The detailed description particularly refers to the following figures,in which:

FIG. 1 is an exploded perspective view of a fixed-bearing kneeprosthesis;

FIG. 2 is a bottom perspective view of the bearing of the kneeprosthesis of FIG. 1;

FIG. 3 is a perspective view of the tibial tray of the knee prosthesisof FIG. 1;

FIG. 4 is a bottom plan view of the tibial tray of FIG. 1;

FIG. 5 is a cross sectional view of the tibial tray of FIG. 4 takenalong the line 5-5 of FIG. 4, as viewed in the direction of the arrows;

FIG. 6 is a bottom plan view of an alternative embodiment of a tibialtray that may be used in the present invention;

FIG. 7 is a cross sectional view of the tibial tray of FIG. 6 takenalong the line 7-7 of FIG. 6, as viewed in the direction of the arrows;

FIG. 8 is a perspective view of a preform for the tibial tray platformportion of the porous metal portion of the tibial tray of FIGS. 1-5;

FIG. 9 is a perspective view of a set of preforms for the extensions ofthe porous metal portion of the tibial tray of FIGS. 1-5;

FIG. 10 is a cross sectional view of the proximal end of the peg preformof FIG. 9 taken along line 10-10 of FIG. 9, as viewed in the directionof the arrows;

FIG. 11 is a cross sectional view similar to FIG. 10, showing theproximal end of the peg preform mounted on the solid metal portion ofthe tray;

FIG. 12 is a perspective view of an alternative form of peg that may beused for the tibial tray or femoral component;

FIG. 13 is a perspective view of another alternative form of peg thatmay be used for the tibial tray or femoral component;

FIG. 14 is a perspective view of an alternative form of preform that maybe used for the porous metal portion of the tibial tray;

FIG. 15 is a cross sectional view of the proximal end of a portion ofthe preform of FIG. 14, taken along line 15-15 of FIG. 14, as viewed inthe direction of the arrows;

FIG. 16 is a cross sectional view of the porous metal preform of FIG.14, taken along line 16-16 of FIG. 14, as viewed in the direction of thearrows;

FIG. 17 is a bottom plan view of the solid metal preform for the tibialtray of FIGS. 4-5, for use with the porous metal preforms of FIGS. 8-9;

FIG. 18 is a cross sectional view of the solid metal preform of FIG. 17,taken along line 18-18 of FIG. 17, as viewed in the direction of thearrows;

FIG. 19 is a bottom plan view of an alternative solid metal preform, foruse with the porous metal preform of FIGS. 14 and 16;

FIG. 20 is a cross sectional view of the solid metal preform of FIG. 19,taken along line 20-20 of FIG. 19, as viewed in the direction of thearrows;

FIG. 21 is an enlarged partial cross sectional view of a portion of thesolid metal preform of FIGS. 17-18

FIG. 22 is an enlarged cross sectional view of a portion of the solidmetal preform of FIGS. 19-20;

FIG. 23 is a view similar to FIG. 22, showing in cross section a portionof the solid metal preform of FIGS. 19-20 and 22 assembled with theporous metal preform of FIGS. 14 and 16;

FIG. 24 is a bottom plan view of a tibial augment that may be used withthe present invention;

FIG. 25 is a bottom plan view of the tibial augment of FIG. 24 assembledwith a tibial tray similar to that shown in FIGS. 6-7;

FIG. 26 is a cross sectional view of the assembly of FIG. 25, takenalong line 26-26 of FIG. 25, as viewed in the direction of the arrows;

FIG. 27 is a perspective view of an ankle prosthesis embodying theprinciples of the present invention;

FIG. 28 is a cross-sectional view, similar to FIGS. 5 and 7, of analternative embodiment of a tibial tray that may be used in the presentinvention;

FIG. 29 is an enlarged cross-sectional view of one of the studs andrecesses of the metal preform of FIG. 28;

FIG. 30 is a cross-sectional view similar to FIG. 29, showing theproximal end of the peg preform mounted on the stud of FIG. 29;

FIG. 31 is a cross-sectional view similar to FIGS. 5, 7 and 28, of analternative embodiment of a tibial tray that may be used in the presentinvention and

FIG. 32 is a cross-sectional view similar to FIGS. 5, 7, 28 and 31, ofan alternative embodiment of a tibial tray that may be used in thepresent invention.

DETAILED DESCRIPTION

The following U.S. patent applications, filed concurrently herewith, arerelated to the present application: “Prosthesis For Cemented FixationAnd Method Of Making The Prosthesis,” filed by Daren L. Deffenbaugh andAnthony D. Zannis (DEP6035USCIP2, U.S. Provisional Patent ApplicationNo. 61/256,546); “Prosthesis With Cut-Off Pegs And Surgical Method,”filed by Daren L. Deffenbaugh and Anthony D. Zannis (DEP6035USCIP3, U.S.Provisional Patent Application No. 61/256,574); “Prosthesis WithSurfaces Having Different Textures And Method Of Making The Prosthesis,”filed as a provisional patent application by Stephanie M. DeRuntz, DarenL. Deffenbaugh, Derek Hengda Liu, Andrew James Martin, Jeffrey A.Rybolt, Bryan Smith and Anthony D. Zannis (DEP6089USCIP1, U.S.Provisional Patent Application No. 61/256,468); and “Prosthesis WithComposite Component,” filed by Daren L. Deffenbaugh and Thomas E.Wogoman (DEP6035USCIP4, U.S. Provisional Patent Application No.61/256,517). All of these patent applications are incorporated byreference herein in their entireties.

While the concepts of the present disclosure are susceptible to variousmodifications and alternative forms, specific exemplary embodimentsthereof have been shown by way of example in the drawings and willherein be described in detail. It should be understood, however, thatthere is no intent to limit the concepts of the present disclosure tothe particular forms disclosed, but on the contrary, the intention is tocover all modifications, equivalents, and alternatives falling withinthe spirit and scope of the invention as defined by the appended claims.

Terms representing anatomical references, such as anterior, posterior,medial, lateral, superior, inferior, etcetera, may be used throughoutthis disclosure in reference to both the orthopaedic implants describedherein and a patient's natural anatomy. Such terms have well-understoodmeanings in both the study of anatomy and the field of orthopaedics. Useof such anatomical reference terms in the specification and claims isintended to be consistent with their well-understood meanings unlessnoted otherwise.

Referring now to FIG. 1, there is shown a knee prosthesis 10. The kneeprosthesis 10 includes a femoral component 12, a tibial tray 14, and abearing 16. The illustrated knee prosthesis 10 is a fixed bearing kneeprosthesis, meaning that no movement is intended to occur between thetibial tray 14 and the bearing 16. It should be understood that theprinciples of the present invention may also be applied to mobilebearing designs, such as rotating platform tibial trays, as well as toother joint prostheses.

The illustrated femoral component 12 includes two condylar articulationsurfaces: a medial condyle articulation surface 18 and a lateral condylearticulation surface 20. These articulation surfaces 18, 20 are solidmetal. The femoral component 12 is configured to be implanted into asurgically prepared end of the patient's femur (not shown), and isconfigured to emulate the configuration of the patient's natural femoralcondyles. As such, the lateral condyle surface 20 and the medial condylesurface 18 are configured (e.g., curved) in a manner which mimics thecondyles of the natural femur. The lateral condyle surface 20 and themedial condyle surface 18 are spaced apart from one another therebydefining an intercondylar articulation surface 22 therebetween. Theintercondylar articulation surface 22 defines a patella groove shaped toreceive and bear against a patella implant component (not shown). Theintercondylar articulation surface 22 may comprise solid metal.

The femoral component 12 also includes bone-engaging surfaces 13, 15opposite the articulation surfaces 18, 22. Some or all of thebone-engaging surfaces 13, 15 may comprise porous metal (as describedbelow) conducive to bony ingrowth. Alternatively, the bone-engagingsurfaces of the femoral component may include cement pockets tofacilitate cementing the component to the bone.

The femoral component 12 of FIG. 1 is a cruciate retaining component,although it should be understood that the principles of the presentinvention are applicable to cruciate substituting prosthetic kneesystems as well.

The femoral component 12 may include features of standard, commerciallyavailable implants, such as those available from DePuy Orthopaedics,Inc., Warsaw, Ind., as well as those available from other suppliers ofprosthetic knee systems. The femoral component 12 may also includefeatures described in the following U.S. patent applications, thedisclosures of which are incorporated by reference herein in theirentireties: “Orthopaedic Knee Prosthesis Having Controlled CondylarCurvature,” Ser. No. 12/488,107 (Docket No. DEP6157USNP); “PosteriorCruciate-Retaining Orthopaedic Knee Prosthesis Having ControlledCondylar Curvature,” Ser. No. 12/165,574 (Docket No. DEP6152USNP);“Orthopaedic Femoral Component Having Controlled Condylar Curvature,”Ser. No. 12/165,579 (Docket No. DEP6151USNP); Ser. No. 12/165,582(Docket No. DEP6057USNP); and “Posterior Stabilized Orthopaedic KneeProsthesis Having Controlled Condylar Curvature,” Ser. No. 12/165,575(Docket No. DEP5923USNP).

The articulation surfaces of the femoral component 12 may be constructedfrom a biocompatible metal, such as stainless steel, titanium, cobaltchrome alloy or titanium alloy, although other materials may also beused. Commonly used alloys include titanium alloy Ti-6Al-4V. In oneaspect of the present invention, the articulation surfaces 18, 20, 22 ofthe femoral component 12 comprise a titanium alloy (such as Ti-6Al-4V,for example) and the bone-engaging surfaces 13, 15 comprise titaniummetal foam (such as a foam made of commercially pure titanium powder,325 mesh (<45 um), produced by a hydride-dehydride process and thatmeets the ASTM F-1580 standard, available from Phelly Materials, Inc.,Bergenfield, N.J., Part No. THD325 for example) or a mix of such apowder with a compatible titanium alloy powder, such as alloy Ti-6Al-4.As discussed in more detail below, the titanium metal foam may comprisea titanium foam preform bonded to the solid titanium alloy throughsintering.

As shown in FIG. 1, the bearing component 16 has a proximal articulationsurface 17 and a distal mounting surface 19 opposite the proximalarticulation surface 17. The proximal articulation surface 17 of thebearing 16 includes a medial bearing surface 21 configured to articulatewith the medial condyle 18 of the femoral component 12 and a lateralbearing surface 23 configured to articulate with the lateral condyle 20of the femoral component 12. The bearing component 16 is modular, and isassembled with the tibial tray 14 intraoperatively and secured theretothrough a mechanical interlocking mechanism, as described in more detailbelow.

The bearing 16 may be made of a polymeric material. Suitable polymericmaterials for the bearing 16 include ultrahigh molecular weightpolyethylene (UHMWPE). The UHMWPE may comprise a cross-linked material,for example. Techniques for crosslinking, quenching, or otherwisepreparing UHMWPE are described in numerous issued U.S. patents, examplesof which include: U.S. Pat. No. 5,728,748 (and its counterparts) issuedto Sun, et al.; U.S. Pat. No. 5,879,400 issued to Merrill et al.; U.S.Pat. No. 6,017,975 issued to Saum, et al.; U.S. Pat. No. 6,242,507issued to Saum et al.; U.S. Pat. No. 6,316,158 issued to Saum et al.;U.S. Pat. No. 6,228,900 issued to Shen et al.; U.S. Pat. No. 6,245,276issued to McNulty et al.; and U.S. Pat. No. 6,281,264 issued to Saloveyet al. The disclosure of each of these U.S. patents is incorporated byreference herein in their entireties. The UHMWPE of the bearing materialmay be treated to stabilize any free radicals present therein, such asthrough the addition of an antioxidant such as vitamin E. Techniques forstabilizing UHMWPE with antioxidants are disclosed, for example, in U.S.Pat. Pub. No. 20070293647A1 (Ser. No. 11/805,867) and U.S. Pat. Pub. No.20030212161A1 (Ser. No. 10/258,762), both entitled “Oxidation-ResistantAnd Wear-Resistant Polyethylenes For Human Joint Replacements AndMethods For Making Them,” the disclosures of which are incorporatedherein in their entireties. It should be understood that the presentinvention is not limited to any particular UHMWPE material or to UHMWPEmaterial for the bearing 16 unless expressly called for in the claims.It is expected that other materials for the bearing 16 are or willbecome available that will be useful in applying the principles of thepresent invention.

The tibial tray 14 includes a platform 24 having a solid metal proximalmounting surface 26 and an opposite distal bone-engaging surface 28. Theillustrated tibial tray 14 also includes a plurality of extensions 30,32, 34, 36, 38 extending distally from the distal bone-engaging surface28 of the platform to distal ends 40, 42, 44, 46, 48 along longitudinalaxes 50, 52, 54, 56, 58 intersecting the distal surface 28 of theplatform 24. Each extension 30, 32, 34, 36, 38 has an axial length,shown, for example, as L₁ and L₂ in FIG. 5 and a thickness, shown, forexample, as T₁ and T₂ in FIG. 5.

The femoral component 12 may also include extensions. For example, pegsmay extend proximally from the bone-engaging surfaces 13, 15 of thefemoral component 12. One such peg is illustrated in FIG. 1 at 39. Thispeg also has a thickness and a length.

In the illustrated femoral component and tibial tray, each extension 30,32, 34, 36, 38, 39 extends outward from a junction with thebone-engaging surfaces 13, 15, 28 of their respective implant components12, 14 to their opposite ends 40, 42, 44, 46, 48, 51. Examples of suchjunctions are shown in FIG. 1 at 69, in FIG. 5 at 60, 62 and 66 and inFIG. 7 at 60A, 62A, 66A. The extensions 30, 32, 34, 36, 38, 39 haveexposed outer surfaces past the junctions; examples of such exposedouter surfaces are shown at 79 in FIG. 1, at 70, 72 and 76 in FIG. 5 andat 70A, 72A and 76A in FIG. 7.

The extensions 30, 32, 34, 36, 38 of the first and second illustratedtibial tray embodiments define a stem 30, 30A and four spaced pegs 32,34, 36, 38, 32A, 34A, 36A, 38A. The stem 30, 30A and pegs 32, 34, 36,38, 32A, 34A, 36A, 38A are configured to be implanted into a surgicallyprepared end of a patient's tibia (not shown) and are configured forstabilizing the tibial component 14, 14A when implanted in a bone of apatient. The stem 30, 30A is generally in the central sagittal plane ofthe tibial component, and the pegs 32, 34, 36, 38, 32A, 34A, 36A, 38Aare spaced from the central sagittal plane of the tibial component.

The stem 30, 30A may be shaped as a standard stem for tibial trays,tapering from the junction 60, 60A with the bone-engaging surface 28,28A of the tray 14, 14A to its distal end 40, 40A. Each of the tibialpegs 32, 34, 36, 38 in the embodiment of FIGS. 1, 4 and 5 is circular intransverse cross-section and end view. Other shapes may also be used forthe pegs. The pegs may be tapered or cylindrical. The pegs may be acombination of shapes, such as a combination of cylindrical andhexagonal, as shown in FIG. 12 at 32B. Alternatively, the pegs may behexagonal in cross-section and end view, as shown in FIG. 13 at 32 C. InFIGS. 12 and 13, the reference numbers are the same as those used in thedescription of the embodiment of FIGS. 1, 4 and 5 for similar parts,followed by the letters “B” and “C”.

The distal end surfaces of the stem and pegs could be flat, spheroidalor some other shape. In the embodiment of FIGS. 1, 4 and 5, the freeends 40, 42, 44, 46, 48, 51 are generally spheroidal. In the embodimentsof FIGS. 12 and 13, the distal ends 42B, 42C are flat. It should beunderstood that the invention is not limited to any particular shape ofpeg or stem unless expressly set forth in the claims.

Another alternative embodiment is illustrated in FIGS. 6-7, where thesame reference numbers have been used as those used in describingcorresponding or similar parts in the embodiment of FIGS. 1 and 4-5,followed by the letter “A”. As described in more detail below, in theembodiment of FIGS. 6-7, all of the extensions 30A, 32A, 34A, 36A, 38Aare part of a single integral preform. The embodiments may sharefeatures as described above and below. Differences between theembodiments are described above and below.

The tibial trays 14, 14A illustrated in FIGS. 1 and 3-7 are compositesof two materials; each tray 14, 14A includes solid metal portions 80,80A and porous metal portions 82, 82A. The solid metal portions 80, 80Aof the illustrated tibial trays 14, 14A define the proximal mountingsurfaces 26, 26A of the platforms 24, 24A and bear against the distalmounting surface 19 of the bearing component 16 when assembled. Thefemoral component of FIG. 1 may also be a composite of a solid metalportion 81 and a porous metal portion 83, with the solid metal portion81 defining the articulating surfaces 18, 20, 22.

The porous metal portions 82, 82A, 83 of the tibial tray 14, 14A andfemoral component 12 define the distal bone-engaging surfaces 28, 28A ofthe tibial platform 24, 24A and the bone-engaging surfaces 13, 15 of thefemoral component 12. These porous metal surfaces 13, 15, 28, 28A facethe bone of the resected proximal surface of the tibial plateau andresected surfaces of the distal femur when implanted, and define amaterial that is conducive to bone ingrowth to allow for uncementedfixation of the tibial platform 24, 24A to the proximal tibia and thefemoral component 12 to the distal femur. As described in more detailbelow, the porous metal portion 82, 82A of the tray 14, 14A extendsproximally from the distal bone-engaging surface 28, 28A and is sinteredto the solid metal portion 80, 80A at a location between the distalbone-engaging surface 28, 28A and the proximal mounting surface 26, 26Aof the platform 24, 24A. The femoral component 12 is similarlyconstructed, with the porous metal portion 83 sintered to the solidmetal portion 81 at a location between the bone-engaging surfaces 13, 15and the articulating surfaces 18, 20, 22.

The porous metal portions 82, 82A, 83 of the tibial tray 14 and femoralcomponent 12 may comprise preforms or plurality of preforms. A firstexample of a set of porous metal preforms for a tibial tray 14 isillustrated in FIGS. 8-9. This set of porous metal preforms includes abase preform 85 with an upper surface 86 opposite from the distalbone-engaging surface 28. The upper surface 86 becomes the interfacewith the solid metal portion 80 of the tray 14 when the porous metalbase preform 85 is sintered to the solid metal portion 80 to make thetibial tray 14. As described in more detail below, the first illustratedbase preform 85 includes a plurality of smooth cylindrical bores oropenings 87, 89, 91, 93, 95 extending from the upper surface 86 to thedistal bone-engaging surface 28.

As illustrated in FIG. 9, the extensions 30, 32, 34, 36, 38 in the firstset of porous metal preforms are discrete components, separate from thebase preform 85 before being sintered together. The extension preformsare circular in transverse cross-section, with diameters substantiallythe same as the diameters of the bores 87, 89, 91, 93, 95 in the basepreform 85. Portions of the extensions adjacent to the proximal ends ofthe extensions fit through the bores 87, 89, 91, 93, 95 and make contactwith the walls of the base preform so that the preform 85 and extensions87, 89, 91, 93, 95 may be sintered together. The proximal ends of thediscrete extensions include blind bores 41, 43, 45, 47, 49 aligned alongthe longitudinal axes 50, 52, 54, 56, 58 of the extensions 30, 32, 34,36, 38. The bores 41, 43, 45, 47, 49 are threaded in this embodiment.For clarity of illustration, FIG. 9 does not show the threads in thesebores 41, 43, 45, 47, 49. An example of such a threaded bore 49 is shownin longitudinal cross-section in FIG. 10.

Other shapes of extensions may be used in combination with the basepreform 85. For example, the extensions corresponding to the pegs maycomprise a combination of a cylindrical portion and a portion that ishexagonal in transverse cross-section. Such a peg is shown in FIG. 12 at32B; the cylindrical portion is shown at 100 and the hexagonal portionis shown at 102. This peg preform also has a flat end surface 42Bopposite the end surface 106 that includes the threaded bore 43B.

Another example of an extension that may be used in the presentinvention is shown in FIG. 13 at 32C. In this example, the extension 32Cis hexagonal in transverse cross-section and in end view. The extensionincludes two flat ends 42C, 106C with a blind bore 43C in one end 106C.In this example, the blind bore 43C is not threaded. Instead, the wallsof the bore 43C define a Morse taper bore for receipt of a Morse taperpost as described in more detail below. The walls defining the bore 43Cmay be tapered at an angle of, for example 3-5°. The bore is widest atthe end 106C and most narrow between the end 106C and the end 42C. Pegpreforms such as those illustrated in FIG. 13 could be used with atibial platform preform similar to that illustrated in FIG. 8, exceptthe bores or holes 89, 91, 93, 95 would have hexagonal shapes to receiveand hold the extension 32C.

An example of a porous metal preform utilizing extensions shaped likethose of FIG. 13 is shown in FIG. 14. In this example, the porous metalpreform 84A includes a base portion 85A and integral extensions 30A,32A, 34A, 36A, 38A. The extensions 32A, 34A, 36A, 38A correspond withpegs and the extension 30A corresponds with the stem of the tibial tray.In this embodiment, the extension 30A corresponding with the stem iscircular in transverse cross-section, although it should be understoodthat other shapes may be used. On the proximal side of the base 85A, anannular raised portion 29A, 31A, 33A, 35A, 37A of each extension extendsabove the planar proximal surface 86A of the base 85A. Each extensionincludes a longitudinal bore or opening 41A, 43A, 45A, 47A, 49A. Asdiscussed above with respect to FIG. 13, in this embodiment, thelongitudinal bores or openings 41A, 43A, 45A, 47A, 49A are Morse taperbores tapering in a distal direction. An enlarged cross-sectional viewof one of the annular raised portions 37A and its associated bore 49A isshown in FIG. 15 as an illustrative example; the walls 110, 112 definingthe tapered bore 49A may be angled at any suitable angle for a Morsetaper bore, such as, for example, 3-5°. The annular projections 29A,31A, 33A, 35A, 37A may be cylindrical in shape, like that shown at 29A,or may have some other shape, such as the hexagonal shape (in transversecross-section and plan view) like those shown at 31A, 33A, 35A and 37A.

A cross-section of the porous metal preform 84A is shown in FIG. 16 asan example. The porous metal preform 84A can be made as a single,integral piece in the molding process and can be otherwise processed instandard ways, such as by machining to create particular features. FIG.7 illustrates the preform 84A of FIGS. 14-16 in combination with a solidmetal portion 80A to form the tibial tray 14A.

Referring back to the solid metal portion 80 of the tibial tray 14, afirst example of a distal surface 120 of the solid metal portion isillustrated in FIG. 17. The distal surface 120 is opposite the proximalmounting surface 26 of the platform 24 of the tibial tray 14 of FIG. 1.As there shown, the distal surface 120 includes a plurality of recesses122, 124, 126, 128, 130. A stud 132, 134, 136, 138, 140 is presentwithin each recess 122, 124, 126, 128, 130. The distal surface of asecond example of the solid metal portion 80A of a tibial tray isillustrated in FIG. 19. As there shown, the distal surface 120A alsoincludes a plurality of recesses 122A, 124A, 126A, 128A, 130A. A stud132A, 134A, 136A, 138A, 140A is present within each recess 122A, 124A,126A, 128A, 130A.

The recesses 122, 124, 126, 128, 130 in the embodiment of FIGS. 17-18are configured to receive the cylindrical ends of the extensions 30, 32,34, 36, 38 and the studs 132, 134, 136, 138, 140 are threaded andcomplementary to the threaded bores 41, 43, 45, 47, 49 so that theextensions 30, 32, 34, 36, 38 may be threaded onto the studs 132, 134,136, 138, 140 to mount the extensions to the studs 132, 134, 136, 138,140. Preferably, the recesses 122, 124, 126, 128, 130 and extensions 30,32, 34, 36, 38 are shaped so that there is metal-to-metal contactbetween the outer surfaces of the extensions 30, 32, 34, 36, 38 and thewalls defining the recesses 122, 124, 126, 128, 130 so that theextensions 30, 32, 34, 36, 38 may be sintered to the solid metal portion80.

The recesses 122A, 124A, 126A, 128A, 130A in the embodiment of FIGS.19-20 are configured to receive the annular raised portions 29A, 31A,33A, 35A, 37A of the preform 84A (or ends of the extensions 30A, 32A,34A, 36A, 38A) and the studs 132A, 134A, 136A, 138A, 140A are taperedand complementary to tapered bores 41A, 43A, 45A, 47A, 49A so that thepreform 84A may be frictionally mounted onto the studs 132A, 134A, 136A,138A, 140A. The recesses 122A, 124A, 126A, 128A, 130A and annular raisedportions 29A, 31A, 33A, 35A, 37A have complementary shapes (hexagonal intransverse cross-sections) so that there is metal-to-metal contactbetween the annular raised portions 29A, 31A, 33A, 35A, 37A and thewalls defining the recesses 122A, 124A, 126A, 128A, 130A so that thepreform 84A may be sintered to the solid metal portion 80A.

Examples of configurations for studs are shown in FIGS. 21-22. The studsmay be threaded, such as stud 134 shown in FIG. 21 to allow for athreaded connection between the studs and the corresponding threadedbores of the extensions; such a connection is illustrated in FIG. 11,where threaded stud 134 is shown connected with extension 38 throughsuch a threaded connection.

The studs may alternatively comprise Morse taper posts having a Morsetaper (generally about 3-5°); such a stud is shown in FIG. 22 at 134A.Generally, the studs are sized, shaped and positioned to be receivedwithin the Morse taper bore (generally about 3-5° ) of a correspondingextension so that the extensions may be mounted on the studs. Such aconnection is illustrated in FIG. 23, where Morse taper stud 134A isshown engaged with Morse taper bore 41A in preform 84A. It should beunderstood that the mounting mechanisms illustrated in FIGS. 21-22 areprovided as examples only; other suitable structures may be used formounting the extensions 30, 32, 34, 36, 38 and preform 84A to thecorresponding solid metal portion 80, 80A, and the invention is notlimited to any particular mounting structure unless expressly called forin the claims.

In the embodiments of FIGS. 5, 7, 11, 18 and 20-23 the studs 134, 134have free ends 135, 135A that do not extend beyond the plane of thedistal surface 120, 120A of the solid metal portion 80, 80A of thetibial tray 14, 14A. An alternative embodiment of a tibial tray withlonger studs is illustrated in FIGS. 28-30, where the same referencenumbers have been used as those used in describing corresponding orsimilar parts in the embodiments of FIGS. 1 4-7, 11, 18 and 20-23followed by the letter “D”. In the embodiment of FIGS. 28-30, the freeends 135D of the studs extend beyond the plane of the distal surface120D of the solid metal portion 80D of the tibial tray 14D. Whenassembled with the porous metal preform 82D as shown in FIGS. 28 and 30,the ends 135D of the studs extend to the plane of the bone-engagingsurface 28D of the porous metal portion of the tibial tray 14D.

In addition, it should be understood that the complementary mountingstructures may be reversed, with the studs being present on theextensions and the complementary recesses being provided on the solidmetal portion of the tibial tray.

The configuration of the proximal mounting surface 26, 26A of the solidmetal portion 80, 80A of the tibial tray 14, 14A may vary depending onthe type of implant. For example, if the prosthesis is a rotatingplatform type of mobile bearing knee prosthesis, the proximal mountingsurface 26, 26A of the tibial tray 14, 14A and the distal mountingsurface 19 of the bearing 16 will be smooth to allow for rotation of thebearing on the mounting surface 26, 26A of the tibial tray 14, 14A. Theembodiment illustrated in FIG. 1 is a fixed bearing design; the proximalmounting surface 26 of the tibial tray 14 and the distal mountingsurface 19 of the bearing 16 in this illustration include complementarylocking features that eliminate or at least minimize any relativemovement between the bearing 16 and the tibial tray 14 when thesecomponents are assembled. These complementary locking features in theillustrated embodiment include pedestals 154, 158, tabs 160, 162 andrecesses 178, 180 on the distal surface 19 of the bearing 16 andbuttresses 184, 186 and undercuts 194, 196, 198 on the proximal mountingsurface 26 of the solid metal portion 80 of the tibial tray 14. Detaileddescriptions of this and other designs for fixed bearing tibial traysmay be found, for example, in the following U.S. patent and patentapplication, the disclosures of which are incorporated by referenceherein in their entireties: U.S. Pat. No. 7,628,818, entitled“Fixed-Bearing Knee Prosthesis Having Interchangeable Components”, filedon Sep. 28, 2007; U.S. patent application Ser. No. 11/860,833, entitled“Fixed-Bearing Knee Prosthesis”, filed on Sep. 25, 2007 and published asUS 20090082873 A1.

Preferably, the solid metal portion 80, 80A of the tibial tray 14, 14Ais a solid metal preform, made from a standard titanium metal alloy. Asuitable alloy for this purpose is Ti-6Al-4V. This alloy is advantageousin that it may be sintered to a porous metal portion made fromcommercially pure titanium powder. This same material may be used forthe solid metal portion of the femoral component 12 as well. It shouldbe understood that some of the advantages of the present invention maybe achieved with other materials, such as a standard cobalt chromemolybdenum alloy; the present invention is not limited to any particularmetal or alloy for the solid metal portions unless expressly called forin the claims.

Preferably, the porous metal portion 82, 82A of the tibial tray 14, 14Ais a titanium metal foam. Such a foam may be made as taught in thefollowing U.S. patent applications: U.S. Publication No. 20080199720A1(U.S. patent application Ser. No. 11/677,140), filed on Feb. 21, 2007and entitled “Porous Metal Foam Structures And Methods”; U.S.Publication No. US 20100098574A1 (U.S. patent application Ser. No.12/540,617) entitled “Mixtures For Forming Porous Constructs”; U.S.Publication No. 20090326674 A1 (U.S. patent application Ser. No.12/487,698) entitled “Open Celled Metal Implants with Roughened Surfacesand Method for Roughening Open Celled Metal Implants;” and U.S.Publication No. 20090292365A1 (U.S. patent application Ser. No.12/470,397) entitled “Implants with Roughened Surfaces”; the disclosuresof all of the above patent applications are incorporated by referenceherein in their entireties. The titanium metal powder used to make theporous metal portion 82, 82A may comprise commercially pure titaniumpowder (such as a titanium powder, 325 mesh (<45 um), produced by ahydride-dehydride process and that meets the ASTM F-1580 standard,available from Phelly Materials, Inc., Bergenfield, N.J., Part No.THD325 for example) or a mix of such a powder with a compatible titaniumalloy powder, such as alloy Ti-6Al-4V. This material is advantageous inthat it can be sintered to a titanium alloy such as Ti-6Al-4V. It isexpected that other grades of commercially pure titanium may be used aswell and that other powder metal materials may be available or developedin the future that can provide at least some of the advantages of thepresent invention; the present invention is not limited to anyparticular material unless expressly called for in the claims.

Although titanium foam is preferred, some of the advantages of thepresent invention may be achieved with alternative materials as well.One example of a suitable alternative material is tantalum porous metal,disclosed, for example in U.S. Pat. No. 5,282,861, entitled “Open CellTantalum Structures for Cancellous Bone Implants and Cell and TissueReceptors,” the disclosure of which is hereby incorporated by referenceherein. Another example of an alternative is a solid metal body madefrom an implantable metal such as stainless steel, cobalt chrome alloy,titanium, titanium alloy or the like and with a porous coating disposedon both the bone-engaging surface and the surface engaging the polymerportion of the tibial tray. One type of porous coating which may be usedas the porous portion 82, 82A of the tibial tray 14, 14A is Porocoat®porous coating which is commercially available from DePuy Orthopaedicsof Warsaw, Ind. The porous metal preform 84A may be made using any ofthe process described in the above-cited patents and patent applicationsor through any standard process.

To make the tibial tray 14, 14A of the invention, the solid metalportion 80, 80A may be made as a solid metal preform by conventionalmethods, such as by casting, machining or some combination of castingand machining Such processes may also be used to make a solid metalpreform for the femoral component 12. For either the tibial tray 14, 14Aor the femoral component 12, the recesses 122, 124, 126, 128, 130, 122A,124A, 126A, 128A, 130A, and posts or studs 132, 134, 136, 138, 140,132A, 134A, 136A, 138A, 140A may be machined into the solid metalpreforms. For studs of the type illustrated in FIG. 21, threads may beformed in the studs 132, 134, 136, 138, 140 as well. For studs of thetype illustrated in FIG. 22, the outer surface of the studs 132A, 134A,136A, 138A, 140A may be shaped to define a Morse taper post.

It is expected that the articulation and mounting surfaces 18, 20, 26 ofthe solid metal portions of the femoral and tibial components 12, 14 maybe treated to increase the lubricity, such as through Type II hardannodization.

The porous metal portion 82, 82A of the tibial tray 14, 14A and femoralcomponent 12 may be made by molding the desired shape, using theprocesses described, for example, in U.S. Publication No. 20080199720A1;U.S. patent application Ser. No. 12/540,617 entitled “Mixtures ForForming Porous Constructs”. Preforms so made can have, for example, abulk porosity (or percent open area or void space) of from about 60% toabout 85% (preferably about 65% to about 75%) as measured by volume, theforced intrusion of liquid mercury, and cross-section image analysis.This porosity/void space corresponds with a preform having a density of15-35% (preferably 25-35%) of theoretical density for a similarly sizedand shaped solid metal component. It should be understood that theporosity can be a product of various factors in the manufacturingprocess, such as the size of pore forming agent used. The resultanttitanium metal foam may be treated to increase its roughness, such as byetching or blasting, as discussed in more detail below.

The molds used for preparing the porous metal portion 82A may be shapedso that the resultant product defines a single, integral porous metalpreform 84A such as that illustrated in FIG. 16. Such a preform can usedto make a tibial tray 14A such as that illustrated in FIGS. 6-7.Alternatively, a plurality of molds may be provided to make individualand discrete extensions 30, 32, 34, 36, 38 and an individual anddiscrete base 85 for the embodiment of FIGS. 4-5 and 8-9. The bores 41,43, 45, 47, 49, 41A, 43A, 45A, 47A, 49A in these components may beformed as part of the molding process or machined into the finishedmetal foam construct. For extensions of the type illustrated in FIGS. 5and 9-12, threads may be formed in the walls defining the bores 41, 43,45, 47, 49. For extensions of the type illustrated in FIGS. 7, 13-16 and23, the walls defining the bores 41A, 43A, 45A, 47A, 49A may be taperedto define Morse taper bores.

The porous metal portion 82, 82A of the implant component and the solidmetal portion 80, 80A of the implant component may then be assembled.For example, for an implant component of the type illustrated in FIGS.6-7, the integral preform 84A may be pressed onto the distal surface120A of the solid metal portion 80A, with the Morse taper studs 132A,134A, 136A, 138A, 140A of the solid metal portion 80A pushed into theMorse taper bores 41A, 43A, 45A, 47A, 49A of the preform 84A, and withthe annular raised portions 29A, 31A, 33A, 35A, 37A of the porous metalpreform 84A received in the recesses 122A, 124A, 126A, 128A, 130Asurrounding the studs 132A, 134A, 136A, 138A, 140A of the solid metalportion or preform 80A, as shown in FIGS. 7 and 22. The Morse taperfrictional connection between the studs and the bores should hold theassembly together until sintering is complete. For an implant componentof the type illustrated in FIGS. 4-5, each porous metal extension 30,32, 34, 36, 38 may be individually assembled with the solid metal base80 by threading the threaded bore 41, 43, 45, 47, 49 of each porousmetal extension 30, 32, 34, 36, 38 onto the threaded stud 132, 134, 136,138, 140 of the solid metal portion or preform 80 until the annular endof the extension is received in the recess 122, 124, 126, 128 130surrounding the stud 132, 134, 136, 138 as shown in FIG. 11. Thisthreaded connection between the studs 132, 134, 136, 138 and the bores41, 43, 45, 47, 49 should hold the assembly together until sintering iscomplete. It should be understood that the Morse taper connection andthreaded connection described above are two examples of complementarystructures for connecting the porous metal extensions to the solid metalportion of the tray; those skilled in the art will recognize that othertypes of connections may be used.

The assembly of the solid metal portion 80, 80A, 81 and the porous metal82, 82A, 83 portion may then be sintered together to form the finaltibial tray 14, 14A or femoral component 12. Sintering may beaccomplished utilizing the same temperatures and times used to form theporous metal portion. For example, as disclosed in U.S. Pub. No.20080199720A1, the assembly may be sintered under the followingconditions to form the final implant component: heating at temperaturesof from about 2100° F. to about 2700° F. (preferably about 2500° F.) forabout 2 hr to about 10 hr (preferably about 3 hr to about 6 hr).

For both the femoral and tibial components, once assembled, the porousmetal portion 82, 82A, 83 defines the bone-engaging surfaces 13, 15, 28,28A of the implant component 12, 14, 14A. In addition, for both thefemoral and tibial components, the solid metal portions 80, 80A, 81contact the bearing 16, both on the mounting side 19 and thearticulation side 17.

As mentioned above, in some situations, it may be desirable to treat theporous metal portion 82, 82A, 83 to increase the roughness of thebone-engaging surfaces. The porous metal portion 82, 82A, 83 may betreated through etching or blasting, for example, to increase theroughness of the outer surface, as disclosed, for example in U.S. Pat.Publication No. 20090326674A1 (U.S. patent application Ser. No.12/487,698) entitled “Open Celled Metal Implants with Roughened Surfacesand Method for Roughening Open Celled Metal Implants,” and U.S. Pat.Publication No. 20090292365A1 (U.S. Pat. App. Ser. No. 12/470,397)entitled “Implants with Roughened Surfaces.” Although the etching andblasting techniques disclosed in those patent applications areadvantageous for use with titanium metal foams, it should be understoodthat the techniques disclosed in these patent applications are providedas examples only; the present invention is not limited to roughenedporous metal or to any particular roughening technique unless expresslycalled for in the claims. The disclosures of these patent applicationsare incorporated by reference herein in their entireties. Suchroughening is expected to make the treated surfaces more conducive tobone ingrowth to improve ultimate fixation of the components.

A variety of other techniques are known for treating porous metalimplants and may be applied to the present invention. For example,calcium phosphate coatings (such as hydroxyapatite) may be applied tothe porous portions of the embodiments of the present invention, with orwithout additional therapeutic agents, as disclosed in U.S. Pat. Pub.No. 20060257358 entitled “Suspension Of Calcium Phosphate ParticulatesFor Local Delivery Of Therapeutic Agents.” Alternatively,electrophoretic deposition of a material such as calcium phosphate maybe used.

As disclosed in U.S. patent application Ser. No. 12/470,397, porousmetal samples (both commercially pure titanium and Ti-6Al-4V) weremachined in the green state and the static coefficients of friction withpolymer bone analogs for the surfaces were found to be 0.52 forcommercially pure titanium and 0.65 for Ti-6Al-4V, with standarddeviations of 0.1. In contrast, porous metal components of the samematerials that were blasted as taught in that patent application hadaverage static coefficients of friction with polymer bone analogs of0.72-0.89 for commercially pure titanium and 1.09-1.35 for Ti-6Al-4V. Asdescribed in that patent application, these tests were performed using apolymer bone analog having a density of about 20 lb/ft3. One example ofa bone analog is Cat. No. FR-4520 from General Plastics ManufacturingCo. (Tacoma, Wash.), which is said to be a “rigid, closed-cellpolyurethane foam” with a density of 20 lb/ft³. The friction test wasperformed using a “sled on a plane” method. The “sled” consisted of the0.75 in×0.75 square metallic matrix samples, whereas each “plane” was amilled sample of Last-A-Foam® 6720 (General Plastics ManufacturingCompany, Tacoma, Wash.), a rigid, closed-cell polyurethane foam with adensity of 20 lb/ft 3. Each sled was connected to a 250 N load cell by10 lb monofilament line and pulled at 10 mm/min for 0.8 in. A weight wasplaced on the sled to create a normal force of 30 N. The static frictioncoefficient was calculated from the maximum force recorded before thefirst 0.5 N drop in force.

Profile parameters of the test samples are also provided in U.S. patentapplication Ser. No. 12/470,397 pursuant to ISO 4287 (1997). As thereshown the Pa, Pp, Pt and Pq values (as defined in that patentapplication) for the samples all at least doubled for the blastedsamples as compared to the machined samples with no blasting.

One application of the etching and blasting roughening techniques of theabove-identified patent applications is to roughen the porous metalportions 82, 82A, 83 of the tibial tray 14, 14A and femoral component12. In addition, it may be advantageous to selectively roughen certainsurfaces of the porous metal portion 82, 82A, 83 while leaving othersurfaces in their as-machined state, with lower roughnesses.Specifically, to facilitate removal of either the tibial tray 14, 14A orthe femoral component 12 from the bone in revision surgery, it may bedesirable to discourage bone ingrowth at the distal ends 40, 42, 44, 46,48, 40A, 42A, 44A, 46A, 48A of the tibial extensions and proximal ends51 of the femoral extensions 39. This may be accomplished by selectivelyroughening the distal bone-engaging surface 24, 24A of the platform andthe outer surfaces of the extensions 30, 32, 34, 36, 38, 30A, 32A, 34A,36A, 38A at the junctions 60, 62, 66, 69, 60A, 62A, 66A and adjacentsurfaces while leaving the ends 40, 42, 44, 46, 48, 40A, 42A, 44A, 46A,48A opposite the junctions 60, 62, 66, 69, 60A, 62A, 66A (and someadjacent surfaces if desired) in the as-machined state. For example, atibial tray made according to this aspect of the invention may have astem 30, 30A and pegs 32, 34, 36, 38, 32A, 34A, 36A, 38A with distalsurfaces 40, 42, 44, 46, 48, 40A, 42A, 44A, 46A, 48A having acoefficient of static friction (with a polymer bone analog comprisingrigid closed-cell polyurethane foam with a density of about 20 lb/ft³)lesson greater than 0.7; the outer surfaces of these pegs 32, 34, 36,38, 32A, 34A, 36A, 38A and stem 30, 30A near the junctions 60, 62, 66,60A, 62A, 66A may have coefficients of static friction (with a polymerbone analog comprising rigid closed-cell polyurethane foam with adensity of about 20 lb/ft³) of more than 0.7. For pegs 32A, 34A, 36A,38A of the type illustrated in FIGS. 7, 12-14 and 16, the flat distalsurface 42A, 44A, 46A, 48A may have a lower coefficient of friction; foran extension of the type illustrated in FIGS. 1, 3-5 and 9, all or partof the spheroidal distal end may have a lower coefficient of friction.Similar results are expected to be obtained with selective etching ofthe extensions. Alternatively, the surfaces of the porous metal portion82, 82A where bone ingrowth is undesirable may be machined, milled,polished or otherwise smoothed to reduce the roughness and/or porosityof the surface. Machining, milling, polishing or smoothing can beexpected to close some or all of the pores and lower the coefficient offriction along the surface. For example, the surfaces where boneingrowth is undersirable may be machined with a standard carbide tiprotating at a standard speed, such as 600 rpm. Machining may be carriedon until the surface is smeared and has a solid rather than porousappearance; about 0.015 inches of material may be removed in thisprocess. It should be understood that a commercial manufacturing processmay be run under different parameters. Machining, milling, polishing orsmoothing can be accomplished when the component is in the green state,before sintering, after sintering, or both before and after sintering.

Alternatively, pores may be selectively filled with metal. As anotheralternative, when molding the porous metal portion of the implant or thepegs and stem, or when sintering the solid metal and porous metalportions together, solid metal pieces may be sintered to the free endsof the pegs and stems. Another alternative would include molding anon-porous biocompatible polymer cap to the ends of the extensions; anexample of such a polymer is polyetheretherketone (PEEK).

The porosity and roughness of other surfaces may also be modified.Considering the embodiment of FIGS. 1 and 3, for example, there aresurfaces of the porous portion 82 that are not intended to engage boneor another part of the implant component. An example of such a surfaceis exposed peripheral surface 150 of the porous portion 82 of the tibialtray 14. This exposed peripheral surface 150 extends generallyperpendicularly from the distal bone-engaging surface 28 to the uppersurface 86 of the porous base 85 in the embodiment of FIGS. 1, 3 and 5.At least some of this exposed peripheral surface can be expected to beengaged by soft tissue when implanted. If this exposed peripheralsurface is rough, adjacent soft tissue could be irritated when the trayis implanted. Accordingly, it may be preferable to smooth these exposedperipheral surfaces, or any surface that may engage soft tissue insteadof bone or another portion of the implant. Any of the methods describedabove could be used. For example, the exposed peripheral surfaces couldbe machined with a carbide bit as described above. The coefficient ofstatic friction of such a surface is expected to be no greater thanthose reported in U.S. patent application Ser. No. 12/470,397 for metalfoam samples machined in the green state and not subjected to anyroughening treatment (0.52 for commercially pure titanium and 0.65 forTi-6Al-4V, with standard deviations of 0.1). Profile parameters of theperipheral exposed surfaces are also expected to be no rougher than thePa, Pp, Pt and Pq values (as defined in U.S. patent application Ser. No.12/470,397) for the metal foam samples machined in the green state. Itis anticipated that the machining parameters could be adjusted tooptimize the surface finishes of the peripheral exposed surfaces anddistal surfaces 40. The exposed porous metal surfaces perpendicular tothe bone-engaging surfaces of the femoral component 12 may be similarlytreated.

An alternative embodiment of a tibial tray is illustrated in FIG. 31,where the same reference numbers have been used as those used indescribing corresponding or similar parts in the embodiments of FIGS. 14-7, 11, 18 and 20-23 followed by the letter “E”. In this embodiment,the periphery of the solid metal portion 80E includes a rim 152 thatextends to the plane of the bone-engaging surface 28E. In thisembodiment, the rim 152 defines a pocket in which the porous metal base85E is received so that the exposed peripheral surface 150E comprisessolid metal. In this embodiment, the tibial tray may be made from a basecomponent, such as a cast component, with pockets configured forcemented fixation, and the pockets could be filled with porous metal,such as a titanium foam, and then sintered.

Another alternative embodiment of a tibial tray is illustrated in FIG.32, where the same reference numbers have been used as those used indescribing corresponding or similar parts in the embodiments of FIGS. 14-7, 11, 18, 20-23 and 31 followed by the letter “F”. In thisembodiment, the periphery of the solid metal portion 80E includes a rim152F that extends to a plane above the plane of the bone-engagingsurface 28F. In this embodiment, the rim 152F defines a pocket in whicha portion of the porous metal base 85F is received. In this embodiment,the porous metal base 85F is recessed from the periphery of the tibialtray to eliminate contact between the porous metal and soft tissue.Thus, the exposed peripheral surface 150F comprises solid metal. In thisembodiment, the tibial tray may be made from a base component, such as acast component, with pockets configured for cemented fixation, and thepockets could be filled with porous metal, such as a titanium foam, andthen sintered. The pockets defined by the rim 152F have a depth shown atT₃ in FIG. 32, and the porous metal base 85F has a thickness shown as T₄in FIG. 32. T₄ is greater than T₃ to ensure that the bone-engagingsurface 28F stands proud to thereby ensure that the surface 28F fullyengages and transfers load to the underlying bone.

Bone loss on the proximal tibia or distal femur can make it difficult toproperly position and support the tibial component 14, 14A or femoralcomponent 12 of the implant system 10 on the bone surface. The prior arthas addressed this problem through the use of wedges or augments.Generally, the wedge or augment is placed between part of thebone-engaging surface of the implant component and part of the bone tosupport part of the implant component on the bone by augmenting part ofthe bone.

Due in part to the fact that the size, shape and anatomy of virtuallyevery patient is different, and the variability in the location andamount of bone loss on the proximal tibia, an extensive number of avariety of wedges and augments have been made available to theorthopedic surgeon. For example, a typical surgical kit will includetibial wedges of different thicknesses and different configurations foruse on either the medial or the lateral sides of the tibial.

In the present invention, the prosthetic knee system or kit 10 mayinclude wedges or augments for both the femoral and tibial sides of thesystem. These augments may comprise porous metal, and more particularly,a porous metal foam of the same material and made under the sameconditions as those discussed above for the porous metal portions 82,82A, 83 of the tibial trays 14, 14A and femoral components 12.

For the femoral side, augments may have features such as those disclosedin the following U.S. Pat. Nos. 6,005,018 and 5,984,969, which areincorporated by reference herein in their entireties. For the tibialside, augments may have features such as those disclosed in U.S. Pat.Nos. 7,175,665 and 5,019,103, which are incorporated by reference hereinin their entireties.

An illustrative tibial augment is shown in FIG. 24 at 200. Theillustrated tibial augment 200 is made of porous metal across its entirelength, width and thickness. The augment 200 includes through-bores 202sized and shaped to receive portions of pegs or extensions (such as pegs32, 34, 36, 38, 32A, 34A, 36A, 38A) that may be present, and may bemounted to the porous metal portion 82, 82A of the tibial tray asillustrated in FIGS. 25-26. Frictional engagement of the augment and thepegs or extensions and the porous metal portion of the tray may besufficient to fix the augment to the tray; otherwise, the augment 200may include additional through-bores sized and shaped to receive screws(not shown) for fixing the augment 200 to the tibial tray 14, 14A; anillustrative through bore is shown at 204 in FIGS. 24-25. The augment200 may also include a recess such as recess 206 to accommodate any stem(such as stem 30, 30A) on the tibial tray 14. Complementary blind boresmay be provided in the tibial tray to receive parts of the screws. Thebores in the tibial tray may be threaded, and may be provided in theporous metal portion 82, 82A or may extend through the porous metalportion 82, 82A and into the solid metal portion 80, 80A. The surfacesdefining the through-bores 202, 204 in the augments may be smooth (i.e.,non-threaded) and the through-bores 204 for the screws may have top andbottom countersinks so that the augment may be used on either the medialor lateral side, as disclosed in U.S. Pat. No. 7,175,665. As shown inFIG. 26, when the augment is mounted on the tibial tray 14A, one surface210 of the augment bears against distal surface 28A of the porous metalportion 82A of the tray 14A and the opposite surface 212 of the augment200 becomes the bone-engaging surface of this side of the tibial tray14A.

The augment 200 may comprise a porous metal foam. For example, theaugment 200 may be made according to the processes disclosed in thefollowing U.S. patent applications: U.S. Publication No. 20080199720A1(U.S. Ser. No. 11/677,140), filed on Feb. 21, 2007 and entitled “PorousMetal Foam Structures And Methods”; U.S. patent application Ser. No.12/540,617 (Docket No. DEP6171USNP) entitled “Mixtures For FormingPorous Constructs”; U.S. patent application Ser. No. 12/487,698 (DocketNo. DEP5922USNP) entitled “Open Celled Metal Implants with RoughenedSurfaces and Method for Roughening Open Celled Metal Implants;” and U.S.patent application Ser. No. 12/470,397 (Docket No. DEP6089USNP) entitled“Implants with Roughened Surfaces.” Exposed peripheral surfaces of theaugments, such as surface 250 in FIGS. 25 and 26, may be treated tosmooth the exposed peripheral surface 250. The smoothing treatment maycomprise, for example, machining as discussed above; alternatively or inaddition, the surface 250 may be masked during any process used toroughed other surfaces of the augment.

To use the system of the present invention, the surgeon would preparethe distal femur and proximal tibia to receive the bone implants 12, 14,14A using conventional techniques and implant the tibial tray andfemoral component using conventional techniques for cementlesscomponents. The tibial bearing 16 is typically assembled with the tibialtray 14, 14A after the tray 14, 14A has been implanted.

After implantation, it is anticipated that bone will grow into theporous metal portion 82, 82A of the tibial tray 14, 14A and porous metalportion 83 of the femoral component 12, including the pegs 32, 34, 36,38, 39, 32A, 34A, 36A, 38A and stem 30, 30A. If the pegs and stem aremade with smoother free ends 40, 42, 44, 46, 48, 51, 40A, 42A, 44A, 46Abone will not, however, grow or grow as vigorously into the smootherfree ends. Thus, it is anticipated that there will be bone ingrowth intothe distal surface 28, 28A of the tibial platform 24, 24A and porousmetal portion 83 of the femoral component 12. In addition, bone ingrowthis also anticipated into the exterior surfaces 70, 72, 76, 79, 70A, 72A,76A of the extensions 30, 32, 34, 36, 38, 39, 30A, 32A, 34A, 36A, 38Aadjacent to the distal surface 28 of the tibial platform 24 and porousmetal portion 83 of the femoral component 12 as well as at the junctions60, 62, 66, 69, 60A, 62A, 66A. Radial pressure along the proximalexterior surfaces 70, 72, 76, 79, 70A, 72A, 76A is expected to beuniform, to stimulate bone ingrowth in all directions on the stem andpegs 30, 32, 34, 36, 38, 39, 30A, 32A, 34A, 36A, 38A. If the ends 40,42, 44, 46, 48, 51, 40A, 42A, 44A, 46A of the pegs and stem are smoother(or comprise solid material) than the rest of the porous metal portion,bone is not expected to grow or to grow as vigorously into the smootherexposed exterior surfaces at the distal ends 40, 42, 44, 46, 48, 51,40A, 42A, 44A, 46A of the extensions 30, 32, 34, 36, 38, 39, 30A, 32A,34A, 36A, 38A.

The extensions 30, 32, 34, 36, 38, 39, 30A, 32A, 34A, 36A, 38A stabilizethe implant component 12, 14, 14A when implanted in a bone of a patient.The central stem 30, 30A provides stability against lift off for thetibial tray. The pegs 32, 34, 36, 38, 32A, 34A, 36A, 38A surrounding thecentral stem 30, 30A and pegs 39 of the femoral component 12 providestability by reducing shear and micromotion, especially after boneingrowth has occurred.

If the exposed peripheral surfaces 150, 250 of the implant componentsare smooth, no soft tissue irritation should occur after the componentsare implanted.

If it becomes necessary to remove the tibial tray 14, 14A or femoralcomponent 12, the surgeon may cut along the distal bone-engaging surface28, 28A of the tibial tray platform 24, 24A (or along the distal surface212 of an augment 200) to sever the connection between the patient'sbone and the tibial tray platform 24, 24A at the interface. If the pegs32, 34, 36, 38, 39, 32A, 34A, 36A, 38A and stem 30, 30A consist ofporous metal foam across their entire thicknesses T₁ and T₂, the surgeonmay also cut through all of the extensions 30, 32, 34, 36, 38, 39, 30A,32A, 34A, 36A, 38A at the junctures 60, 62, 66, 69, 60A, 62A, 66A of theextensions 30, 32, 34, 36, 38, 39, 30A, 32A, 34A, 36A, 38A and thedistal surface 28, 28A of the tibial platform 24, 24A and bone-engagingsurfaces 13, 15 of the femoral component 12 using a bone saw and easilyremove the tibial platform 24, 24A and femoral component 12. Such aresult is generally not possible with pegs and stems made of solidtitanium or cobalt chrome alloy, since bone saws cannot generally cutthrough solid metal. To remove the extensions 30, 32, 34, 36, 38, 39,30A, 32A, 34A, 36A, 38A, the surgeon may then cut around the outerperimeter of each extension 30, 32, 34, 36, 38, 39, 30A, 32A, 34A, 36A,38A to sever the connection between the bone and the extensions 30, 32,34, 36, 38, 39, 30A, 32A, 34A, 36A, 38A. Such cuts around the perimetersmay be made, for example, through use of a trephine saw. Each extension30, 32, 34, 36, 38, 39, 30A, 32A, 34A, 36A, 38A may then be readilyremoved. Notably, if the free ends of the extensions are smooth, littleor no bone ingrowth will have occurred at the ends of the extensions, sothe removal of the stem and pegs should be made easier.

As indicated above, sawing through the stem and pegs 30, 32, 34, 36, 38,39, 30A, 32A, 34A, 36A, 38A, 30D, 32D, 36D, 30E, 32E, 36E is made easierif the stem and pegs at the junctions 60, 62, 66, 69, 60A, 62A, 66A,60D, 62D, 66D, 60E, 62E, 66E consist of porous metal rather than solidmetal. Generally, it is believed that the stem and pegs may be cutthrough transversely with a standard surgical saw if the material is25-35% of theoretical density. Notably, in the illustrated embodiments,the titanium alloy studs 132, 134, 136, 138, 140, 132A, 134A, 136A,138A, 140A, 134D, 134E do not extend beyond the plane of bone-engagingsurface 28, 28A, 28D, 28E; therefore, in cutting through the extensions30, 32, 34, 36, 38, 39, 30A, 32A, 34A, 36A, 38A, 30D, 32D, 36D, 30E,32E, 36E, the surgeon need not cut through the solid metal studs 132,134, 136, 138, 140, 132A, 134A, 136A, 138A, 140A, 34D, 134E.

It is anticipated that a standard surgical saw could cut through asomewhat more dense material. In addition, it is anticipated that astandard surgical saw could cut through a composite of materials, suchas a small diameter central core of solid metal (e.g. titanium alloy)surrounded by a porous metal foam (e.g. commercially pure titanium).Accordingly, although for purposes of ease of removal, it is preferredthat the entire thicknesses of the extensions be porous metal at thejunctions, other considerations may call for a composite of materials tobe used.

Thus, the present invention provides a knee prosthesis with a tibialimplant component and femoral component suitable for optimizedcementless fixation. Moreover, the implant components can be readilyremoved from the bone in revision surgery to conserve native bone.

It will be appreciated that the principles of the present invention areexpected to be applicable to other joint prostheses as well. An exampleof such a joint prosthesis is shown in FIG. 27. The joint prosthesis ofFIG. 27 is an ankle prosthesis. The illustrated ankle prosthesiscomprises a talar component 312, a composite distal tibial component 314and a bearing 316. In the illustrated embodiment, the composite distaltibial component 314 comprises a distal solid metal portion 320 and aproximal porous metal portion 322, sintered together as described abovefor the knee prosthesis 10. As in the knee prosthesis 10, the solidmetal portion 320 and the bearing may have mounting surfaces withcomplementary locking features (not shown) so that the bearing 316 canbe fixed to the solid metal portion 320 of the tibial component 314. Theillustrated distal tibial component 314 has a proximal extension 324extending proximally from the bone-engaging surface 326 of the tibialcomponent 314. The proximal extension 324 may provide porous metal outersurfaces for engaging the bone or the distal portion 328 may compriseporous metal and the proximal portion 330 comprise porous metal with aporosity or reduced coefficient of static friction as described above. Asimilar extension could be provided in the talar component if desired.

While the disclosure has been illustrated and described in detail in thedrawings and foregoing description, such an illustration and descriptionis to be considered as exemplary and not restrictive in character, itbeing understood that only illustrative embodiments have been shown anddescribed and that all changes and modifications that come within thespirit of the disclosure are desired to be protected.

For example, the number and configurations of the extensions may bevaried. For a tibial tray, for example, the tray could include pegs butno central stem. Although the illustrated tibial trays have four pegs,fewer pegs may be acceptable.

Other variations are possible as well. For example, the extensions 30,32, 34, 36, 38, 39, 30A, 32A, 34A, 36A, 38A, 30D, 32D, 36D, 30E, 32E,36E could be made as modular components to be assembled with a baseplate intraoperatively if desired. The base plate could comprise aporous preform like that shown in FIG. 8 at 85 sintered to a solid metalportion such as that shown at 80 in FIG. 5. The threaded and Morse taperconnections described above should be sufficient to hold the componentstogether without sintering, particularly if the studs are longer, asshown in the embodiment of FIGS. 28-30. The extensions and base platemay be provided in a kit form, with the base plate and extensions beingdiscrete components as shown in FIGS. 8-9 and 17-20; the extensions inthe kit could have differing properties, such as size or surface finish,and the surgeon may chose the most appropriate extension for theparticular patient intraoperatively. For example, a set of extensionscould be provided with porous distal ends and a second set of extensionscould be provided with smooth distal ends to accommodate surgeonpreference.

There are a plurality of advantages of the present disclosure arisingfrom the various features of the apparatus, system, and method describedherein. It will be noted that alternative embodiments of the apparatus,system, and method of the present disclosure may not include all of thefeatures described yet still benefit from at least some of theadvantages of such features. Those of ordinary skill in the art mayreadily devise their own implementations of the apparatus, system, andmethod that incorporate one or more of the features of the presentinvention and fall within the spirit and scope of the present disclosureas defined by the appended claims.

We claim:
 1. A joint prosthesis comprising: a first component having anarticulation surface, a solid metal portion, a porous metal portion anopposite bone-engaging surface that is part of the porous metal portion;a bearing having an articulation surface shaped to bear against thearticulation surface of the first component and an opposite surface; anda second component having a mounting surface and an oppositebone-engaging surface; wherein the first component has a centralsagittal plane and includes a plurality of recesses and a plurality ofspaced studs, each stud being received within one recess and having anend, the recesses and studs being spaced from the central sagittal planeof the implant component and being part of the solid metal portion; aplurality of extensions, each extension mounted on one stud andextending out from the bone-engaging surface to an end, each extensionhaving an outer surface between the end and the bone-engaging surface, apart of each extension being received in one recess; wherein: the porousmetal portion and extension comprise a titanium metal foam and the solidmetal portion comprises a titanium alloy; the extensions and the porousmetal portion meet at junctions comprising titanium metal foam; theporous metal portion, solid metal portion and extensions are bondedtogether through sintering; the junctions lie in a plane; and the endsof the studs do not extend beyond the plane of the junctions.
 2. Thejoint prosthesis of claim 1 wherein each stud defines a Morse taper postand wherein each extension includes a Morse taper bore engaging thestud.
 3. The joint prosthesis of claim 1 wherein the joint prosthesis isa knee prosthesis, the first component comprises a distal femoralcomponent and the second component comprises a proximal tibial tray. 4.The joint prosthesis of claim 1 wherein the joint prosthesis is an ankleprosthesis and the first component comprises a distal tibial component.5. A joint prosthesis comprising: a first component having anarticulation surface and an opposite bone-engaging surface; a bearinghaving an articulation surface shaped to bear against the articulationsurface of the first component and an opposite surface; and a secondcomponent having a solid metal portion, a porous metal portion, amounting surface and an opposite bone-engaging surface that is part ofthe porous metal portion; wherein the second component has a centralsagittal plane and includes a plurality of recesses and a plurality ofspaced studs, each stud being received within one recess and having anend, the recesses and studs being spaced from the central sagittal planeof the implant component and being part of the solid metal portion; aplurality of extensions, each extension mounted on one stud andextending out from the bone-engaging surface to an end, each extensionhaving an outer surface between the end and the bone-engaging surface, apart of each extension being received in one recess; wherein: the porousmetal portion and extension comprise a titanium metal foam and the solidmetal portion comprises a titanium alloy; the extensions and the porousmetal portion meet at junctions comprising titanium metal foam; theporous metal portion, solid metal portion and extensions are bondedtogether through sintering; the junctions lie in a plane; and the endsof the studs do not extend beyond the plane of the junctions.
 6. Thejoint prosthesis of claim 5 wherein the joint prosthesis is a kneeprosthesis, the first component comprises a distal femoral component andthe second component comprises a proximal tibial tray.